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The Brachial Plexus the Brachial Plexus The brachial plexus The brachial plexus Formation Supraclavicular portion Trunks Divisions Infraclavicular portion Cords Branches The brachial plexus The brachial plexus is a network of nerves that supply the upper limb The brachial plexus extends from the neck into the axilla Formation It is formed by five roots from the anterior (ventral) primary rami of C5,6,7,8, and T1 Formation the roots of the brachial plexus should not be confused with The ventral dorsal & the ventral and dorsal rami form ventral roots of the roots of a spinal n. roots which unite to the brachial plexus form the spinal nerves Supraclavicular portion Scalenus medius The roots lie in the neck between scalenus anterior and scalenus medius Scalenus anterior muscles Supraclavicular portion C5 & C6 unite to form the upper trunk Supraclavicular portion C8 & T1 unite to form the lower trunk Supraclavicular portion C7 continues as the middle trunk Trunks of the brachial plexus The trunks lie in the posterior triangle of the neck and can be felt in the angle between the clavicle and sternocleidomastoid muscle clavicle Trunks of the brachial plexus The inferior trunk lies on the first rib posterior to the subclavian artery Inferior trunk Divisions of the brachial plexus Behind the clavicle, each trunk divides into anterior and posterior divisions Trunks of the brachial plexus the anterior divisions supply anterior (flexor) parts while the posterior divisions supply posterior (extensor) parts of the upper limb Infraclavicular portion The three posterior divisions unite to form the posterior Posterior cord cord Infraclavicular portion the anterior divisions of the upper and lateral cord middle trunks unite to form the lateral cord Infraclavicular portion the anterior division of the lower trunk continues as the medial cord medial cord Cords of the brachial plexus The cords are arranged around the second part of the axillary artery as indicated by their names. Branches of the brachial plexus Each cord of the brachial plexus divides into a number of branches, 2 of them are terminal Branches of the brachial plexus there are also a number of supraclavicular branches Bracial plexus plan If you find it difficult the names attributed to the different parts of the brachial plexus, the diagram will remind you that the order is roots, trunks, divisions, cords, and branches Branches of the roots Dorsal scapular (C5) which supplies rhomboids muscles and levator scapula Branches of the roots Nerve to subclavius (C5 & 6) which descends in front of the brachial plexus and the subclavian artery in the neck, it may give a contribution to the phrenic nerve (C5) this branch, when present is called the accessory phrenic nerve. Branches of the roots The third branch is the long thoracic nerve (C5,6, & 7) descends behind the brachial plexus and supplies serratus anterior muscle Suprascapular nerve From the upper trunk arises the suprascapular nerve Suprascapular nerve The suprascapular nerve passes laterally across the neck, then through the suprascapular notch in the scapula to supply supraspinatus and infraspinatus muscles Infraclavicular branches The infraclavicular branches are derived from the cords Each cord divides into 2 terminal branches. Branches of the lateral cord The lateral cord has 3 branches mainly the lateral pectoral nerve and 2 terminal branches, the musculocutaneous and the medial root of the median nerve Lateral pectoral nerve The lateral pectoral nerve pierces the clavipectoral fascia to supply pectoralis major muscle Lateral pectoral nerve laterall medial pectoral n. pectoral n. sends a communicating Pectoralis minor loop to the medial pectoral nerve, through communicating loop which it supplies pectoralis minor Axillary v. lateral cord muscle Axillary a. Medial cord posterior cord Musculocutaneous nerve pierces coracobrachialis muscle, supplying it before doing so Musculocutaneous nerve it then supplies the muscles of the flexor (anterior) compartment of the arm mainly biceps and brachialis therefore it is known as the BBC nerve Musculocutaneous nerve It ends by becoming the lateral coetaneous nerve of the forearm Lateral root of the median nerve The lateral root of the median nerve is the direct continuation of the lateral cord Median nerve The median nerve arises by medial and lateral roots from the corresponding cords of the brachial plexus Median nerve the medial root crosses the axillary artery to join the lateral root so the median nerve is formed at first lateral to the axillary artery. Median nerve The median nerve has no branches in the axilla and is responsible for the supply of the flexor compartment of the forearm and the palm. Branches of the medial cord The medial cord has 5 branches the ulnar nerve and medial root of the median nerve are its two terminal branches Ulnar n. Medial pectoral nerve laterall axillary a. axillary v. medial pectoral n. pectoral n. The medial pectoral Pectoralis minor nerve passes through pectoralis minor major Pectoralis supplying it then it supplies pectoralis Axillary v. lateral Medial pectoral n. cord major Axillary a. Medial cord Medial cutaneous nerve of arm The medial cutaneous nerve of the arm, is a small nerve that runs medial to the axillary Axillary a. vein and supplies the skin over the medial side and front of the arm Medial cutaneous nerve of arm communicates with the intercostobrachial nerve medial cutaneous nerve of the forearm runs between the axillary artery and vein and supplies skin of the medial side of Axillary a. the forearm medial cutaneous nerve of the forearm Runs between the axillary artery and vein superficial to the ulnar nerve Ulnar nerve is the largest branch of the medial cord runs between the axillary artery and Axillary a. vein but at a more posterior plane than the smaller medial cutaneous nerve of the forearm Ulnar nerve receives a branch from the lateral cord in more than 90% of cases has no branches in the axilla is mainly concerned with the innervation of the palm. Medial root of the median nerve crosses the axillary artery to form the median nerve lateral to the artery Axillary a. Branches of the brachial plexus Note that the musculocutaneous, median, and ulnar nerve form the letter M, which serves as the key to the brachial plexus Branches of the posterior cord The posterior cord of the brachial plexus has 5 branches the axillary and radial nerves are its 2 terminal branches. Upper and lower subscapular nerves The upper and lower subscapular nerves supply the upper and lower parts of subscapularis muscle Lower subscapular nerve the lower subscapular nerve supplies teres major muscle in addition to suscapularis Thoracodorsal nerve Runs between the subscapular nerves, it runs down on subscapularis towards latissimus dorsi which it supplies, it accompanies the subscapular vessels. Axillary nerve It is inappropriately named since it supplies nothing in the axilla The first thing it does is to quit the axilla by passing backwards through the posterior wall of the axilla Axillary nerve It leaves the axilla through the quadrangular space accompanied by the posterior circumflex humeral vessels just below the capsule of the shoulder joint to which it sends an articular branch (so it is sometimes called the circumflex nerve) Axillary nerve It winds around the surgical neck of the humerus deep to deltoid muscle which it supplies, it also supplies teres minor, and the upper lateral cutaneous nerve of the arm Radial nerve The radial nerve provides the major nerve supply of the extensor muscles of the upper limb (arm and forearm) Radial nerve It lies behind the axillary artery on the glistening tendon of latissimus latissimus dorsi muscle dorsi tendon Radial nerve Branches in the axilla posterior cord triceps (long head) posterior cutaneous of arm triceps (medial head) Radial nerve It leaves the axilla posteriorly through a triangular space between the humerus, teres major, and the long head of triceps .
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